Provider Demographics
NPI:1285391698
Name:COLUMBUS FAMILY CARE CENTER LLC
Entity type:Organization
Organization Name:COLUMBUS FAMILY CARE CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACOBINA
Authorized Official - Middle Name:ASUNSULEY
Authorized Official - Last Name:ADAMU
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:614-274-4171
Mailing Address - Street 1:2800 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-2654
Mailing Address - Country:US
Mailing Address - Phone:614-274-4171
Mailing Address - Fax:
Practice Address - Street 1:2800 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-2654
Practice Address - Country:US
Practice Address - Phone:614-274-4171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUMBUS FAMILY CARE CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-19
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0449809Medicaid
OH0470394Medicaid